Skip to main content
Log in

A 2-year prospective study of bone metabolism and bone mineral density in adolescents with anorexia nervosa

  • Published:
Journal of Neural Transmission Aims and scope Submit manuscript

Summary

Osteopenia and osteoporosis are complications of adolescent anorexia nervosa (AN) and may result in a permanent deficit of bone mass in adulthood. It is still unclear if a complete catch-up in bone mineral density (BMD) is possible after weight rehabilitation in AN.

Methods. We investigated bone formation (bAP, PICP), bone resorption (CTX) and BMD (lumbar spine, femoral neck) along with endocrinological parameters in 19 girls with AN (14.4 ± 1.6 years) and in 19 healthy controls for 2 years after inpatient re-feeding.

Results. Re-feeding normalised bone formation activity in patients. The pattern of bone turnover in patients after 2 years was similar to the pattern healthy controls had shown 2 years before. BMD of patients was significantly lower than in controls and did not change throughout the entire study.

Conclusions. Weight rehabilitation leads to prolonged normalization of bone turnover in adolescent AN. Since we could not observe a “catch up” effect in BMD of girls with AN in a 2-year follow-up, BMD of these patients needs to be carefully monitored until adulthood to detect early osteoporosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • SA Abrams TJ Silber NV Esteban et al. (1993) ArticleTitleMineral balance and bone turnover in adolescents with anorexia nervosa J Pediatr 123 326–331 Occurrence Handle8345437 Occurrence Handle10.1016/S0022-3476(05)81714-7 Occurrence Handle1:STN:280:DyaK3szkslSrtw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • L Audi DM Vargas M Gussinye (2002) ArticleTitleClinical and biochemical determinants of bone metabolism and bone mass in adolescent female patients with anorexia nervosa Pediatr Res 51 497–504 Occurrence Handle11919336 Occurrence Handle10.1203/00006450-200204000-00016 Occurrence Handle1:CAS:528:DC%2BD38XjtFSgsbo%3D

    Article  PubMed  CAS  Google Scholar 

  • LK Bachrach DK Katzman IF Litt et al. (1991) ArticleTitleRecovery from osteopenia in adolescent girls with anorexia nervosa J Clin Endocrinol Metab 72 602–606 Occurrence Handle1997514 Occurrence Handle1:STN:280:DyaK3M7kslGgsA%3D%3D Occurrence Handle10.1210/jcem-72-3-602

    Article  PubMed  CAS  Google Scholar 

  • S Bass PD Delmas G Pearce et al. (1999) ArticleTitleThe differing tempo of growth in bone size, mass, and density in girls is region-specific J Clin Invest 104 795–804 Occurrence Handle10491415 Occurrence Handle1:CAS:528:DyaK1MXmtFGltbk%3D Occurrence Handle10.1172/JCI7060

    Article  PubMed  CAS  Google Scholar 

  • SL Bass L Saxon AM Corral et al. (2005) ArticleTitleNear normalisation of lumbar spine bone density in young women with osteopenia recovered from adolescent onset anorexia nervosa: a longitudinal study J Pediatr Endocrinol Metab 18 897–907 Occurrence Handle16279368

    PubMed  Google Scholar 

  • KT Borer (2005) ArticleTitlePhysical activity in the prevention and amelioration of osteoporosis in women: interaction of mechanical, hormonal and dietary factors Sports Med 35 779–830 Occurrence Handle16138787 Occurrence Handle10.2165/00007256-200535090-00004

    Article  PubMed  Google Scholar 

  • CM Bulik PF Sullivan F Tozzi et al. (2006) ArticleTitlePrevalence, heritability, and prospective risk factors for anorexia nervosa Arch Gen Psychiatry 63 305–312 Occurrence Handle16520436 Occurrence Handle10.1001/archpsyc.63.3.305

    Article  PubMed  Google Scholar 

  • A Caillot-Augusseau MH Lafage-Proust P Margaillan et al. (2000) ArticleTitleWeight gain reverses bone turnover and restores circadian variation of bone resorption in anorexic patients Clin Endocrinol 52 113–121 Occurrence Handle10.1046/j.1365-2265.2000.00879.x Occurrence Handle1:STN:280:DC%2BD3c7ptFKltw%3D%3D

    Article  CAS  Google Scholar 

  • J Castro J Toro L Lazaro et al. (2002) ArticleTitleBone mineral density in male adolescents with anorexia nervosa J Am Acad Child Adolesc Psychiatry 41 613–618 Occurrence Handle12014794 Occurrence Handle10.1097/00004583-200205000-00019

    Article  PubMed  Google Scholar 

  • JE Compston C McConachie C Stott et al. (2006) ArticleTitleChanges in bone mineral density, body composition and biochemical markers of bone turnover during weight gain in adolescents with severe anorexia nervosa: a 1-year prospective study Osteoporos Int 17 77–84 Occurrence Handle15889315 Occurrence Handle10.1007/s00198-005-1904-6 Occurrence Handle1:CAS:528:DC%2BD2MXhtlWkt7rJ

    Article  PubMed  CAS  Google Scholar 

  • CG Fairburn PJ Harrison (2003) ArticleTitleEating disorders Lancet 361 407–416 Occurrence Handle12573387 Occurrence Handle10.1016/S0140-6736(03)12378-1

    Article  PubMed  Google Scholar 

  • MM Fichter S Herpertz N Quadflieg et al. (1998) ArticleTitleStructured interview for anorexic and bulimic disorders for DSM-IV and ICD-10: updated (third) revision Int J Eat Disord 24 227–249 Occurrence Handle9741034 Occurrence Handle10.1002/(SICI)1098-108X(199811)24:3<227::AID-EAT1>3.0.CO;2-O Occurrence Handle1:STN:280:DyaK1cvhtlClug%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • PE Fournier R Rizzoli DO Slosman et al. (1997) ArticleTitleAsynchrony between the rates of standing height gain and bone mass accumulation during puberty Osteoporos Int 7 525–532 Occurrence Handle9604047 Occurrence Handle10.1007/BF02652557 Occurrence Handle1:STN:280:DyaK1c3mslCjtA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • J Frey J Hebebrand B Muller et al. (2000) ArticleTitleReduced body fat in long-term followed-up female patients with anorexia nervosa J Psychiatr Res 34 83–88 Occurrence Handle10696835 Occurrence Handle10.1016/S0022-3956(99)00038-2 Occurrence Handle1:STN:280:DC%2BD3c7lvF2jug%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • B Galusca C Bossu N Germain et al. (2006) ArticleTitleAge-related differences in hormonal and nutritional impact on lean anorexia nervosa bone turnover uncoupling Osteoporos Int 17 888–896 Occurrence Handle16541206 Occurrence Handle10.1007/s00198-005-0063-0 Occurrence Handle1:CAS:528:DC%2BD28XkvVCnurs%3D

    Article  PubMed  CAS  Google Scholar 

  • S Grinspoon E Thomas S Pitts et al. (2000) ArticleTitlePrevalence and predictive factors for regional osteopenia in women with anorexia nervosa Ann Intern Med 133 790–794 Occurrence Handle11085841 Occurrence Handle1:STN:280:DC%2BD3M%2FjsFKjtw%3D%3D

    PubMed  CAS  Google Scholar 

  • KA Halmi WS Agras S Crow et al. (2005) ArticleTitlePredictors of treatment acceptance and completion in anorexia nervosa: implications for future study designs Arch Gen Psychiatry 62 776–781 Occurrence Handle15997019 Occurrence Handle10.1001/archpsyc.62.7.776

    Article  PubMed  Google Scholar 

  • WJ Hannan P Tothill SJ Cowen et al. (1996) ArticleTitleWhole body bone mineral content in healthy children and adolescents Arch Dis Child 78 396–397

    Google Scholar 

  • D Hartman A Crisp B Rooney et al. (2000) ArticleTitleBone density of women who have recovered from anorexia nervosa Int J Eat Disord 28 107–112 Occurrence Handle10800020 Occurrence Handle10.1002/(SICI)1098-108X(200007)28:1<107::AID-EAT13>3.0.CO;2-M Occurrence Handle1:STN:280:DC%2BD3c3mtFCmug%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • M Heer C Mika I Grzella et al. (2002) ArticleTitleChanges in bone turnover in patients with anorexia nervosa during eleven weeks of inpatient dietary treatment Clin Chem 48 754–760 Occurrence Handle11978602 Occurrence Handle1:CAS:528:DC%2BD38XjtlWnt7g%3D

    PubMed  CAS  Google Scholar 

  • M Heer C Mika I Grzella et al. (2004) ArticleTitleBone turnover during inpatient nutritional therapy and outpatient follow-up in patients with anorexia nervosa compared with that in healthy control subjects Am J Clin Nutr 80 774–781 Occurrence Handle15321821 Occurrence Handle1:CAS:528:DC%2BD2cXnsVWhsrc%3D

    PubMed  CAS  Google Scholar 

  • DB Herzog DJ Dorer PK Keel et al. (1999) ArticleTitleRecovery and relapse in anorexia and bulimia nervosa: a 7.5-year follow-up study J Am Acad Child Adolesc Psychiatry 38 829–837 Occurrence Handle10405500 Occurrence Handle10.1097/00004583-199907000-00012 Occurrence Handle1:STN:280:DyaK1MzjtlyrtQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • W Herzog H Minne C Deter et al. (1993) ArticleTitleOutcome of bone mineral density in anorexia nervosa patients 11.7 years after first admission J Bone Miner Res 8 597–605 Occurrence Handle8511987 Occurrence Handle1:STN:280:DyaK3s3ovFylsA%3D%3D

    PubMed  CAS  Google Scholar 

  • JZ Ilich M Skugor T Hangartner et al. (1998) ArticleTitleRelation of nutrition, body composition and physical activity to skeletal development: a cross-sectional study in preadolescent females J Am Coll Nutr 17 136–147 Occurrence Handle9550457 Occurrence Handle1:STN:280:DyaK1c3gvFyhtQ%3D%3D

    PubMed  CAS  Google Scholar 

  • DK Katzman (2005) ArticleTitleMedical complications in adolescents with anorexia nervosa: a review of the literature Int J Eat Disord 37 IssueIDSuppl S52–S59 Occurrence Handle15852321 Occurrence Handle10.1002/eat.20118

    Article  PubMed  Google Scholar 

  • A Klibanski BMK Biller DA Schoenfeld et al. (1995) ArticleTitleThe effects of estrogen administration on trabecular bone loss in young-women with anorexia-nervosa J Clin Endocrinol Metab 80 898–904 Occurrence Handle7883849 Occurrence Handle10.1210/jc.80.3.898 Occurrence Handle1:CAS:528:DyaK2MXktlOntbw%3D

    Article  PubMed  CAS  Google Scholar 

  • E Lantzouni GR Frank NH Golden et al. (2002) ArticleTitleReversibility of growth stunting in early onset anorexia nervosa: a prospective study J Adolesc Health 31 162–165 Occurrence Handle12127386 Occurrence Handle10.1016/S1054-139X(02)00342-7

    Article  PubMed  Google Scholar 

  • AR Lucas LJ Melton SuffixIII CS Crowson et al. (1999) ArticleTitleLong-term fracture risk among women with anorexia nervosa: a population-based cohort study Mayo Clin Proc 74 972–977 Occurrence Handle10918862 Occurrence Handle1:STN:280:DC%2BD3czovVahtQ%3D%3D Occurrence Handle10.4065/74.10.972

    Article  PubMed  CAS  Google Scholar 

  • Lunar News (1999) Bone growth in children. 2–4. Lunar Cooperation

  • CJ Maloney SC Rastogi (1970) ArticleTitleSignificance tests for Grubb’s estimators Biometrics 26 671–676 Occurrence Handle10.2307/2528714

    Article  Google Scholar 

  • M Misra A Klibanski (2002) ArticleTitleEvaluation and treatment of low bone density in anorexia nervosa Nutr Clin Care 5 298–308 Occurrence Handle12557813 Occurrence Handle10.1046/j.1523-5408.2002.05605.x

    Article  PubMed  Google Scholar 

  • M Misra A Klibanski (2006) ArticleTitleAnorexia nervosa and osteoporosis Rev Endocr Metab Disord 7 91–99 Occurrence Handle16972186 Occurrence Handle10.1007/s11154-006-9005-1 Occurrence Handle1:CAS:528:DC%2BD2sXht12mug%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • NA Rigotti RM Neer SJ Skates et al. (1991) ArticleTitleThe clinical course of osteoporosis in anorexia nervosa. A longitudinal study of cortical bone mass JAMA 265 1133–1138 Occurrence Handle1995999 Occurrence Handle10.1001/jama.265.9.1133 Occurrence Handle1:STN:280:DyaK3M7ktVyhsw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • E Seeman MK Karlsson Y Duan et al. (2000) ArticleTitleOn exposure to anorexia nervosa, the temporal variation in axial and appendicular skeletal development predisposes to site-specific deficits in bone size and density: a cross-sectional study J Bone Miner Res 15 2259–2265 Occurrence Handle11092408 Occurrence Handle10.1359/jbmr.2000.15.11.2259 Occurrence Handle1:STN:280:DC%2BD3MzgsFKltw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • E Seeman GI Szmukler C Formica et al. (1992) ArticleTitleOsteoporosis in anorexia nervosa: the influence of peak bone density, bone loss, oral contraceptive use, and exercise J Bone Miner Res 7 1467–1474 Occurrence Handle1481732 Occurrence Handle1:STN:280:DyaK3s7isl2gtg%3D%3D Occurrence Handle10.1002/jbmr.5650071215

    Article  PubMed  CAS  Google Scholar 

  • LA Soyka S Grinspoon LL Levitsky et al. (1999) ArticleTitleThe effects of anorexia nervosa on bone metabolism in female adolescents J Clin Endocrinol Metab 84 4489–4496 Occurrence Handle10599707 Occurrence Handle10.1210/jc.84.12.4489 Occurrence Handle1:CAS:528:DyaK1MXotVGru7c%3D

    Article  PubMed  CAS  Google Scholar 

  • LA Soyka M Misra A Frenchman et al. (2002) ArticleTitleAbnormal bone mineral accrual in adolescent girls with anorexia nervosa J Clin Endocrinol Metab 87 4177–4185 Occurrence Handle12213868 Occurrence Handle10.1210/jc.2001-011889 Occurrence Handle1:CAS:528:DC%2BD38XntFOlsrc%3D

    Article  PubMed  CAS  Google Scholar 

  • T Talluri RJ Lietdke A Evangelisti (1999) ArticleTitleFat-free mass qualitative assessment with bioelectric impedance analysis (BIA) Ann N Y Acad Sci 873 94–98 Occurrence Handle10372155 Occurrence Handle10.1111/j.1749-6632.1999.tb09454.x Occurrence Handle1:STN:280:DyaK1MzgtVOnsQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • P Vestergaard C Emborg RK Stoving et al. (2002) ArticleTitleFractures in patients with anorexia nervosa, bulimia nervosa, and other eating disorders – a nationwide register study Int J Eat Disord 32 301–308 Occurrence Handle12210644 Occurrence Handle10.1002/eat.10101

    Article  PubMed  Google Scholar 

  • E Wentz D Mellstrom C Gillberg et al. (2003) ArticleTitleBone density 11 years after anorexia nervosa onset in a controlled study of 39 cases Int J Eat Disord 34 314–318 Occurrence Handle12949922 Occurrence Handle10.1002/eat.10192

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Additional information

The first two authors contributed equally

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mika, C., Holtkamp, K., Heer, M. et al. A 2-year prospective study of bone metabolism and bone mineral density in adolescents with anorexia nervosa. J Neural Transm 114, 1611–1618 (2007). https://doi.org/10.1007/s00702-007-0787-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00702-007-0787-4

Navigation